TKR TKR post op fatigue and back pain

[MissyG]

I had my left knee replaced in April 2015. I just had my right knee replaced with reconstructive work to repair a fracture at the top of my tibia on February 21, 2024. Second time around I knew what to expect so knee recovery has been easier. I faithfully did all pre-op exercises and continue with physio and post-op exercises. I have 115 degree bend and the leg is straight. It had quite a severe curvature pre-op so I am thrilled to see a straight leg.
What I have not been prepared for is the constant fatigue and terrible sciatica on the right side, plus heel pain on the surgery leg. When I go for a walk, my knee could keep going but I have to stop because of the sciatica. I’ve asked physio for help with back stretches, and I ice it too along with my knee.
I want to nap every afternoon as my bed is the only place I can get relief for my back.

Would any of you have suggestions to help me relieve fatigue and back pain?

 

[Maggie M]

@MissyG I had a TKR December 20 and dealt with fatigue for a while. I really think I am just now getting past that, I think it just comes with any major surgery, it will pass.
I also had sciatica and back problems after my surgery, I understand what you mean when you say you could go further if it wasn’t for the back pain. I couldn’t even ride very far in a vehicle.
I’ve been seeing a chiropractor for about a month now who has helped me tremendously! I think my back was used to being one way for forever and now that my knee is replaced it has to get used to another way!

 

[mendogal]

@MissyG Welcome to BoneSmart!

Yes the energy drain is real because on a cellular level all your nutrition and energy is going towards healing.

Sciatica is not uncommon among our members post op. Some find ice helpful, some heat.

 

[mendogal]

Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[benne68]

Welcome back, @MissyG It sounds like you are doing extremely well for less a month post-op!

I empathize with you about the sciatica. I also struggled with sciatic pain following both of my TKRs. That curvature you mention prior to surgery likely forced misalignment in your back and hips as you had to modify your gait for the bad knee. As our bodies struggle to adapt to our new alignment, we can end up with pain in our backs, hips and -- really, all up and down the leg.

In addition to giving me stretches, my physical therapist did some acupressure to help relieve the discomfort. I tried to replicate it at home sitting on a tennis ball. Also, once I got the okay from my surgeon, I went for regular sessions of therapeutic massage to release the low back and hips.

 

[MissyG]

Thank you so much to everyone who replied. It is somewhat comforting to know that fatigue and sciatic pain is not unusual, especially at this early stage. I have scoliosis and severe degenerative discs, which has always been relieved by sitting. But not now. And I know that my gait has changed a great deal with this new straight leg. I plan to get my orthotics adjusted and hope that may help. I’ve also been off my usual anti inflammatory medication and will be able to resume once I’m done with the blood thinners. So I am hopeful that all will be resolved, I just have to be patient.

 

[mendogal]

We're here for supporting you through everything you experience - worries, new milestones in progress, needing to vent.

 

[Layla]

Hello and Welcome to recovery, Missy! I am sorry you're having a bit of a rough time, especially because what once brought you relief, is currently not helping. Hopefully the orthotics adjustment and resumption of your
anti-inflammatory meds will bring you comfort and relief. We're here for you! Happy One Month Anniversary!
@MissyG

 

[MissyG]

Hi everyone,
I’m now going into my sixth week after RTKR. Since surgery I’ve had numbness in my heel pad, numbness on the inside of my ankle and discomfort on the outside of my ankle. At my 3 week checkup my surgeon said it should improve when “things quiet down.” I see him again mid April and will bring it up again.
Has anyone else had this problem?

I start my anti inflammatories again today so fingers crossed my back pain eases. I’ve not been able to get my orthotics adjusted as it’s a two hour drive away and I’m not up to sitting that long in a car yet. But I am wearing the ones I have in the house all the time.

Fatigue continues, but I understand that’s still normal at this stage.

I do have a good tip to share. When I wake with leg pain during the night, I’m not awake enough to go down stairs for an ice pack, I rub Biofreeze on my knee and down my leg, not on my incision. It gives a lovely cold sensation that soothes the pain right away and lasts for about 30 minutes. So I’m able to get back to sleep.

Thanks for any help.

 

[benne68]

t my 3 week checkup my surgeon said it should improve when “things quiet down.” I see him again mid April and will bring it up again.
Has anyone else had this problem?

Yes, it is normal to experience pain up and down our legs and even into our backs and hips as we recovery.

As you know, all of the soft tissue in your leg was traumatized by the surgical procedure and it takes time to heal from that. What's more, it's very likely that you were favoring the bad knee prior to surgery, putting the rest of your body out of alignment. Now that the knee is fixed, all that soft tissue has to "relearn" what to do.

I know it's hard to be patient, but it does get better with time.

 

[MissyG]

Thank you Benne68, it’s a relief to hear this is normal. Dr. Google had me a bit scared. I definitely favoured that leg before and it was shorter due to the curvature of it. Not having the arthritic pain in that knee and feeling its strength is a joy. I just want the rest of my body to be happy too.
Patience comes with knowing this is normal and on track. I really appreciated your encouragement.

 

[benne68]

Dr. Google had me a bit scared.

Yes, Dr. Google does that to everyone!

Stick with us here on BoneSmart and we'll support you throughout this journey. It takes time, but it does get better.

 

[Layla]

Happy Two Month Anniversary, Missy!
I hope you're doing well. Wishing you a wonderful week.
@MissyG

 

[lrj]

. I’ve also been off my usual anti inflammatory medication and will be able to resume once I’m done with the blood thinners.

That was a big one for me. I didn't feel bad while on blood thinners, but as soon as I was able to stop I felt amazing!
I can't relate to the sciatic pain. My pre op knee pain was so bad I couldn't sleep. I skeptically tried acupuncture and it made a big difference. Still needed meds, but it helped give an extra umph that allowed me to sleep and do limited activities.
I was also surprised by fatigue. I anticipated recovery to be similar to when I broke my leg (snapped tib/fib that required surgery) when I was 14. Nothing is like it was when I was 14. I'll have to remember that in 20 or so years when I likely will be upgrading from PKR to TKR. 50-60 something will be nothing like 37.